B13/1994 IMPLEMENTATION OF THE COMMONWEALTH SENIORS HEALTH CARD (CSHC)

DATE OF ISSUE:  9 MARCH 1994

IMPLEMENTATION OF THE COMMONWEALTH SENIORS HEALTH CARD (CSHC)

INTRODUCTION

The purpose of this instruction is to provide information concerning the Commonwealth Seniors Health Card (CSHC), which will be implemented on 1 July 1994.

BACKGROUND

2.As part of the 1992/93 Budget, the Government extended fringe benefits to all service pension recipients and, on 1 January 1994,  replaced the Pensioner Health Benefits (PBH) card with a new laminated Pensioner Concession Card (PCC).

3. In the 1993 Budget, the Government announced the provision of a Seniors Health Card to assist those retirees who qualified for fringe benefits, under the income test, but either failed the assets test or were excluded by the residency requirements.  This card will provide a limited range of concessions and is targeted at those retirees who are asset rich but income poor due to the prevailing economic climate.

4.In order to ensure that there is no confusion with the existing 'State Seniors Card (SSC)', it has been decided to prefix the word 'Commonwealth' to the name, hence the 'Commonwealth Seniors Health Card (CSHC)'.

CONCESSIONS

5.A person who qualifies for the CSHC will be able to obtain :

• concessional pharmaceuticals under the Pharmaceutical Benefits Scheme (PBS). The concessional rate is $2.60 per item, until total eligible expenditure reaches the 1994 PBS Safety Net threshold of $135.20 a year, after which further pharmaceuticals are free for the remainder of the calendar year. Note, that the 1994 PBS Safety Net crossover arrangements may apply;

• free hearing aids and concessional maintenance services including batteries (at a maximum of $25 a year) available through Australian Hearing Services (AHS), previously known as the National Acoustics Laboratory; and

• dental treatment under the Commonwealth Dental Health Program.  Access to dental treatment will be available through State or Territory public dental clinics.

QUALIFICATION

6.The CSHC extends concessional benefits to those persons who exceed the assets test cut-off limit or who do not meet the 10 year residency rule.  To obtain the CSHC the person must :

• either:

-be a veteran with qualifying service and of pension age  (i.e. men that are 60 years or older and women that are 55 years* or older); or

-qualify for  age pension (i.e. men that are 65 years or older or women who are 60 years* or older);

• have income below the basic ordinary income test cut-out points.  (Details relating to this are set out in paragraphs 11 to 13.)

• be living in Australia and have Australian residency; and

• lodge a formal application.

*Note: As at 1 July 1995, the qualifying age for women will be gradually lifted in 6 monthly steps every two years. The new age requirements will apply to women applicants from this date.

7.The residency rules are less stringent than under the normal pension residency rules as the person will only need to satisfy the Department that they are a permanent resident.  They will not need to have 10 years of residency in Australia.

8.Partners must meet the DSS age pension age to qualify for the CSHC unless they qualify as veterans in their own right.

9.Dependant children do not qualify for the card or the benefits associated with the card.

DVA TREATMENT CARD HOLDERS

10.The CSHC extends limited concessional benefits to persons who do not qualify for a service pension. Those persons holding DVA treatment entitlement cards i.e. PTEC, DTEC, etc. are already covered for the concessional benefits available under the CSHC, as are the holders of Pensioner Concession Cards (PCC).  The only treatment cardholders, who may benefit from the CSHC, are STEC holders, who also meet the remaining eligibility requirements.

THE BASIC ORDINARY INCOME TEST CUT-OUT POINTS

11.The basic ordinary income test cut-out point is the level of income at which eligibility for pension is lost.  The cut-out points may vary as a result of indexation on I January, 20 March, 1 July and 20 September, each year.

12.As at 6 January 1994, the cut-out points are:

• $730.80 per fortnight (or $19000.80 per year) - for a single pensioner;

• $608.60 each per fortnight (or $15823.60 each per year) - for a member of a couple; and

• $718.80 each per fortnight ($18688.80 each per year) for a couple accepted as being separated for medical reasons.

13.These cut-out points are currently increased by $24 per fortnight (or $624.00 per year) for each dependent child.  For the purposes of the CSHC, these rates are not increased for any allowances the person may be entitled to receive from DVA i.e. Rent Assistance or Dependant Child Add-on Allowance.

TIMETABLE FOR CARD ISSUE

14.The CSHC will be introduced on 1 July 1994 .  Applications may be accepted from the date of announcement by the Minister and processed by the Branches, from 14 March 1994. Data for the initial issue,  will be extracted from the system 28 May 1994 and  the CSHC will be posted to clients on 23 June 1994.

15.The first issue period of the CSHC will be from 1 July 1994 to 31 July 1995.  Subsequent and ongoing bulk issues will be from 1 August to 31 July.  In this way, the income limits affected by the July indexation will be reflected in the income cut-off points printed on the carrier.

APPLICATIONS

16.A formal application will need to be lodged for the CSHC.  The application will be lodged, using the existing Service Pension (SP) claim form, as detailed below:

• for new pension applicants, the existing SP claim form will be used to determine entitlements to a SP (and PCC) or the CSHC. A separate form is not to be raised; or

• where a person has previously applied for a SP and was not eligible, they may apply for a re-assessment by submitting an updated SP claim form, and as such will be assessed for CSHC.

17. Details relating to Tax File Number (TFN) and residency are not required for the CSHC. Staff are to ensure that TFN details are not requested or recorded for CSHC applications. The claim form is to be stamped on the front cover "For CSHC Issue Only".

18.The stamps will be distributed by PD&I to VAAS units from the date of publicity, which is expected to commence in mid March 1994.

19.If a person is eligible for a part-rate service pension and doesn't want payment, then they may qualify for the CSHC and lodge a formal application.  These people, however, should be advised of the greater benefits available with the PCC.

BRANCH OFFICE PROCESSING OF CLAIMS FOR CSHC

20.Claims processing will be as simplified as possible.  The verification of the age of the claimant will be by manual examination of documents or through existing screen data.  The examiner will also need to verify that the person meets all the basic eligibility requirements.

21.For new SP applicants, the assessment for CSHC will be a follow-on to rejection of the SP claim. Both new and previous SP applicants will need to be processed  using the Trial screen, to assess the claimants current level of income and assets.  The income and assets limits are based on the same income and assets limits used to determine SP payability. Where income is under the income limit and assets are in excess, the examiner will reject for SP payment only but accept for CSHC issue.  In any other situation e.g. where income is over the limit and assets are under the limit, or if income is over and assets are over, a case would be rejected for the CSHC.

22.Claimants for Invalidity or Carer SP will not be eligible for CSHC unless the person qualifies for Age SP.

23.As age and residential status are factors for determining individual eligibility, it is feasible for only one partner of a couple to qualify for the SHC.  This is different to SP where the partner is eligible for partners SP when the veteran is in payment.

SYSTEMS CHANGES

GENERAL CHANGES

24.Online systems changes are being made to accommodate production and issue of CSHCs to eligible persons. Both the date of issue and the date of reissue will be recorded on screen.

25.The system will allow for reissue of all CSHCs annually i.e. a bulk data extract of eligible CSHC holders will be conducted. The system will  identify and produce reports on those who hold a card at any given time.

RECORDING OF ELEGIBILITY FOR CSHC

26.A simple claims management network, titled CMS/EATERS will be introduced to allow for the recording of eligible clients. The operation of CMS/EATERS is  detailed in Annex A to this instruction.

HEALTH CARD DATA SYSTEM

27.The CSHC is to be recorded on the Entitlement Card system and will utilise the Health entitlement numbering regime ie. the veteran's DVA file number, with a DVA State prefix but no alpha suffix. The spouse has the veteran's Entitlement number with the 'A' suffix.  The Entitlement number will link the HSH network with DVA.  The Entitlement number, shown on the CSHC, differs from the Pension number shown on the PCC. The PCC will be adjusted to this system on the next bulk issue. It should be noted that as part of the Fringe Benefits Phase II of the Fringe Benefits project, Fringe Benefits information is now recorded on the EATERS facility (i.e. EN.SC).

DEATH PROCESSING SYSTEM

28.System changes will allow Branches to cease eligibility after death of a client.

DAILY ADVICES PROGRAM

29.For the daily advices program, there is a requirement to include some notification in respect of CSHC.  The General Information Sheet (GIS) will not be amended as this sheet only goes out to those in payment of a pension.  The only change will be to advices for pensioners who are cancelled due to the assets test.  If a Branch examiner confirms that a person is eligible for the CSHC at that time, it is appropriate for the officer to issue the CSHC.

BEREAVEMENT

30.The CSHC will not be recalled following death.

RECALL OF CARDS

31.Cards will not be recalled where the client has lost eligibility through annual student reviews, deeming rate changes, interest rate refresh, etc. or from those whose income changes so that they just fail the income test.  These people will be sent an advice letter asking them to destroy their cards rather than have specific card recall procedures.  They will then be invited to reapply should their circumstances change.

THE CARD

32.The card will be manufactured from 1mm thick polished core plastic and attached to a carrier.  The card will be preprinted with standard information and glued, with a light adhesive, face down on a carrier sheet. The back of the card will be personalised and the income cut-out points shown on the carrier sheet. Both card and carrier will be printed by the contractor, using laser printers. Individual cards may be issued on an emergency basis and personalised, using a typerwriter, by VASS counter staff.

33.The front of the card will display the DVA logo, along with the signature strip and the 'valid to' date.

34.The back of the cards will be preprinted with the following information :

.A BRIEF RUNDOWN ON BENEFITS,

.THE VALID TO DATE, AND

.THE NAME OF THE DEPARTMENT TO POST OR RETURN LOST CARDS.

35.The back of the cards will be personalised with the following:

.CLIENT'S NAME,

.ADDRESS,

.ENTITLEMENT NUMBER, AND

.A DATE OF GRANT.

36.The entitlement number is the pension number, expressed as a combination of the state prefix, pension number and the 'blank' suffix for veterans and 'A', 'B', 'C' etc for the dependants. The date of grant and the Entitlement No, shown on the card,  will be required for pharmaceutical benefits as the normal PBS Safety Net crossover arrangements  will apply from the date of issue.

THE CARRIER

37. The carrier will contain information on the benefits available, the obligations of the cardholder, and a general question and answer section.

OBLIGATIONS OF CSHC HOLDERS

38.Cardholder obligations will be displayed on the front of the carrier.  Cardholders will be required to notify of increases in income above the relevant income limits, and changes in their address and marital status.  They will also need to notify the department if they are granted a DSS pension or benefit.  The introductory text on the carrier will reflect the general cut off limits for the three basic categories of clients.

PRODUCTION OF THE CARD

39.The DVA card will be produced by the current contractor, R.L. Polk Pty Ltd, and will be a plastic card. It is intended to use the limited size of the CSHC issue as a trial of the plastic card. Any production difficulties will be monitored by Central Office and Branch Offices are asked to monitor and report on client reactions and any comments. DSS will produce their own similiarly designed version of the CSHC 'in-house' and using the laminated cardboard press-out card, previously trialled with the PCC.

NEW ISSUES AND LOST CARDS

40.It is proposed that cardholder data will be batched and despatched to the contractor on a weekly basis.  A tape will be provided to the contractor who will undertake to produce and provide a card within a 24 to 48 hour turnaround.

41.It is further proposed to have a blank stock of cards available which can be typed up in emergencies.  These will be available from the VAAS unit counters.

PUBLICITY

42.Publicity will commence from mid March 1994.  The introduction of the card will be publicised in the National papers, radio, general media and ex-service networks.  A poster, advertising the CSHC, has been prepared for display  through the Pharmacies.  Publicity will include information on lodging applications, which will be able to commence being processed in March, for the initial card issue.

KAY GRIMSLEY

ASSISTANT SECRETARY

INCOME SUPPORT BRANCH

BENEFITS PROGRAM

ANNEX :A.  RECORDING OF ELIGIBILITY FOR CSHC

ANNEX A

RECORDING OF ELIGIBILITY FOR CSHC

General

1.The CSHC will be recorded using a claims management system, under CMS/EATERS. This system will be available for recording claims on 23 March 1994.

Network Transactions

2.To allow the recording, production and issue of the CSHC, a number of screen amendments and transaction codes have been introduced. A graphical presentation of the claims network is attached, as Appendix 1,  and the functions are further described in the following paragraphs.

Classify Pension-CM.CP

3.A new registration class of Seniors Card (Item Number 31) will be placed on the CM.CP menu (page 2). Registration action will put a Seniors Card case into 'await prepare recording' stage. (See Appendix 2).

Stage Complete-CM.SC

4.This facility will allow progression of a Seniors Card case from 'await prepare recording stage' (CMS) to 'prepare recording stage' (EATERS) or from 'await prepare recording stage' to 'case withdrawn stage'. The 'stage complete facility' will also allow movement of a case from 'prepare recording stage' (EATERS) back to 'await prepare recording stage' (CMS).

Seniors Card-EN.SC

5.This new EATERS data collection screen (see Appendix 3) will allow recording of client eligibility for a Seniors Card case, whilst in 'prepare recording stage', for a person indicator, i.e.; VET, SPS, or DEF:

FieldValid InputDescription

Eligibility TypeSHC (default)Seniors Health Card

ResultON or OFFEligibility Gain or Loss

Effective DateddmmyyGrant Date - ON Date

Eligibility Loss Date.- OFF Date

Decision BodyDEL (default)Delegate

Decision Date ddmmyyDate of Delegates decision

or default today's date

6.The EATERS data collection screen will have an action field which will allow users to Add (ADD or A), Change (CHG or C) and Delete (DEL or D) items as required if a current record is present.

Data Collection-EN.DC

7.Following data collection on the Seniors Card screen, entering a "Y" in this facility will move the Seniors Card case from 'prepare recording stage' into 'record decision stage'. The associated print summary transaction will also be required to produce a data collection summary sheet for this classification.

Data Collection Reprint-EN.RP

8.This facility will allow reprint of the data collection summary sheet for a Seniors Card case.

Record Decision-EN.RD

9.When a delegate is satisfied with the data collection, entering a "Y" in this facility will move a Seniors Card case from 'record decision stage' to case finalisation'. The appropriate CSHC eligibility ON or OFF will be inserted onto the client data base using the information recorded on the EN.SC screen.

10.Entering a "N" in this facility will return the Seniors Card case from 'record decision stage' to 'prepare recording stage' for correction of data collection.

CMS Statistics

11.The normal range of CMS statistic (EN.RS) and case reports (EN.RC) will be available for Seniors Card classification.

ACF2 Security Access

Branches will need to identify those positions that require ACF2 security access to the relevant transactions and arrange that access through their local ADP section.

This document has been rekeyed to be put onto the General

APPENDIX 1

COMMONWEALTH SENIORS HEALTH CARD

CLAIMS MANAGEMENT NETWORK

Transaction — Stage — Transaction

Case Withdrawn

Register Seniors

Card Classification — CM.CP — CM.SC — Withdraw Case

Await Prepare

Recording

Move case into

Eaters — CM.SC — CM.SC — Move case

out of Eaters

Await Prepare

Recording

Data collection &

Summary print — EN.SC &EN.RD — Delegate

EN.DC(N)Decision

(Y)No

Record Decision

Delegate Decision — EN.RD

Yes(Y)

Case Finalisation

CLASSIFY PENSION SCREEN(CM.CP) Page 2

EATERS MENU(EN.SM)

APPENDIX  3

SENIORS CARD SCREEN (EN.SC)

CLASSIFY PENSION SCREEN(CM.CP) Page 2

EATERS MENU(EN.SM)

APPENDIX  3

SENIORS CARD SCREEN (EN.SC)